PROJECT SUMMARY/ABSTRACT The goal of this proposal is to create and validate health information exchange (HIE)-enabled versions of two proposed National Quality Forum (NQF) e-Quality measure for potentially preventable emergency department (ED) visits: 1) returns to the ED within 72 hours (ED returns) and 2) frequent ED users, then evaluate their impact on interventions currently using only siloed institution-specific data. The project will be implemented with the New York Clinical Information Exchange (NYCLIX), an existing HIE that spans most of the major hospitals in New York City (NYC). One limitation to the current approach to quality measurement is that it is usually institution- specific, limited to a single provider organization. The advent of HIE presents an opportunity to think about quality in new ways and create new patient-centric quality measures that gather data wherever patients seek care. The specific hypotheses in this proposal are that 1) HIE-enabled e-Quality measures will allow better detection of ED quality assurance (QA) cases and frequent ED users and 2) use of these measures in ongoing programs will improve ED QA processes and decrease the number of visits by frequent ED users. The Aims of this project are 1) Develop and validate a health information exchange-based tool to support new inter-institutional e-Quality measures for ED returns and frequent ED users, 2) Compare the performance of the new inter-institutional e-Quality measures to current site- specific measures with quantitative and qualitative methods and 3) Implement the new inter- institutional e-Quality measures in existing QA and case management programs and quantify the impact The primary outcomes include the number of patients captured in the 72-hour return and frequent ED user cohorts with and without the new inter-institutional measures. Secondary outcomes include the number of 72-hour return cases constituting quality issues, and the number of visits by frequent ED users with and without the new inter-institutional measures.